PubMed · 10154501
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P L Owens. 1995. Access managers--expand your thinking.. https://pubmed.ncbi.nlm.nih.gov/10154501/
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INTRODUCTION: A 20-month quality improvement project was undertaken in order to improve the patient admission process at a 350-bed French public psychiatric hospital. In addition to improving the quality of patient admissions, the project was expected to increase the expertise of quality improvement team members. METHODS: The project team consisted of two physicians, three heads of nursing, one senior manager, one member of the admissions staff and one secretary. A pharmacist acted as internal facilitator. The team used problem-solving methodology to identify and correct any shortcomings in the existing admission process. Validated data were collected before and after implementation of corrective actions. The team was trained to become more effective on the basis of a published how-to manual for building an effective work team. Team effectiveness was compared before and after the project. RESULTS: Changes in relevant variables were as follows: (i) patients going through the admissions department (40% after corrective action, versus 20% before); (ii) no delay in admission formalities for patients entering hospital by long-standing arrangement (100% versus 20%); and (iii) no delay in admission formalities for patients whose hospitalisation was not predetermined but foreseen (45% versus 0%). The expertise of team members improved in terms of the four tested items: meeting customers' needs and expectations (P< 2 x 10(-6)); contribution of the team to the internal quality improvement strategy (P< 0.01); understanding of the methodology (P< 0.04) and accountability (P< 2 x 10(-5)). Improvements in adherence to the mission statement were also observed. A total of 728 hours were spent on project management. DISCUSSION: Objective improvements were achieved; in particular, the team was shown to have become more effective. The extent to which the lessons learned here can be extrapolated may depend on the openness to change of members of other project teams. CONCLUSION: This project demonstrated that it is possible to put theory into action and thereby make progress. In order to advance further, a second quality improvement project is planned.
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OBJECTIVES: To assess the effects of centralisation of accident and emergency (A&E) services in a large urban setting. The end points were the quality of patient care judged by time to see a doctor or nurse practitioner, time to admission and the cost of the A&E service as a whole. METHODS: Sheffield is a large industrial city with a population of 471000. In 1994 Sheffield health authority took a decision to centralise a number of services including the A&E services. This study presents data collected over a three year period before, during and after the centralisation of adult A&E services from two sites to one site and the centralisation of children's A&E services to a separate site. A minor injury unit was also established along with an emergency admissions unit. The study used information from the A&E departments' computer system and routinely available financial data. RESULTS: There has been a small decrease in the number of new patient attendances using the Sheffield A&E system. Most patients go to the correct department. The numbers of acute admissions through the adult A&E have doubled. Measures of process efficiency show some improvement in times to admission. There has been measurable deterioration in the time to be seen for minor injuries in the A&E departments. This is partly offset by the very good waiting time to be seen in the minor injuries unit. The costs of providing the service within Sheffield have increased. CONCLUSION: Centralisation of A&E services in Sheffield has led to concentration of the most ill patients in a single adult department and separate paediatric A&E department. Despite a greatly increased number of admissions at the adult site this change has not resulted in increased waiting times for admission because of the transfer of adequate beds to support the changes. There has however been a deterioration in the time to see a clinician, especially in the A&E departments. The waiting times at the minor injury unit are very short.